Healthcare Provider Details

I. General information

NPI: 1144980061
Provider Name (Legal Business Name): LEIDI P. HERNANDEZ MARTINEZ ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 BLVD LUIS A FERRE EDIF PORRATA PILA 208
PONCE PR
00728
US

IV. Provider business mailing address

1832 BLVD LUIS A FERRE EXT SAN ANTONIO
PONCE PR
00728-1818
US

V. Phone/Fax

Practice location:
  • Phone: 787-451-6978
  • Fax:
Mailing address:
  • Phone: 787-396-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number80
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: